A 49-year-old man with a 60 pack-year smoking history presented with a 1-month history of progressively worsening pain in the posterior aspect of the right side of his neck. He denied recent neck trauma, fevers, chills, weight loss, dyspnea, chest pain, dysphagia, odynophagia, and otalgia and had no history of head and neck surgery or radiation therapy. His medical history was remarkable for approximately 6 months of intermittent coughing of blood-tinged sputum. He reported no recent travel. He considered himself otherwise healthy and had not seen a primary care provider in more than 25 years. The physical examination was notable for a moderately tender area of diffuse induration measuring approximately 3 × 3 cm in greatest dimension and edema of the right posterior neck area along the cervical spine at the hairline. The findings of the rest of the head and neck evaluation were unremarkable. Laboratory studies revealed a slightly elevated white blood cell count (11 700/μL; reference range, 4000-7000/μL) (to convert to ×109/L, multiply by 0.001), with a normal differential cell count. The erythrocyte sedimentation rate and C-reactive protein level were elevated to 50 mm/h (reference range, 0-15 mm/h) and 3.4 mg/dL (reference range, 0-0.5 mg/dL) (to convert to nanomoles per liter, multiply by 9.524), respectively. The results of a QuantiFERON-TB Gold test (Cellestis Inc) and a serologic test for human immunodeficiency virus were negative. A computed tomographic scan of the neck showed a paravertebral abscess with erosion of the vertebral transverse process (Figure 1). The abscess was percutaneously drained, and round yeast with budding daughter cells were observed on Gram staining. A computed tomographic scan of the chest subsequently revealed a spiculated mass (Figure 2) in the right lower lobe. Bronchoscopy with biopsy and lavage demonstrated similar thick-walled yeast (Figure 3). View LargeDownload Figure 1. View LargeDownload Figure 2. View LargeDownload Figure 3. What is your diagnosis?
Archives of Otolaryngology - Head & Neck Surgery
– American Medical Association
Published: Jun 1, 2012
Keywords: hiv,radiation therapy,neck,edema,chest pain,dyspnea,biopsy,weight reduction,physical examination,deglutition disorders,cough,erythrocyte sedimentation rate,fever,gram's stain,abscess,bronchoscopy,cell count,chills,earache,irrigation,laboratory techniques and procedures,neck injuries,pain,reference values,serologic tests,sputum,yeasts,c-reactive protein measurement,medical history,chest,swallowing painful,cervical spine,head and neck,vertebrae,head and neck surgery,white blood cell count increased,hairline,quantiferon-tb gold test,erosion,transverse process of vertebra,smoking,travel